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1.
Int J Colorectal Dis ; 2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34751417

RESUMO

PURPOSE: To determine the selection criteria, postoperative complications, bowel function, and prognosis of stapled ileal pouch-anal anastomosis (IPAA) and hand-sewn IPAA for ulcerative colitis (UC). METHODS: We defined our surgical indications and strategy, and compared the postoperative complications, bowel function, and prognoses between patients who underwent stapled and hand-sewn IPAA for UC at the Yokohama City University Medical Center between 2004 and 2017. RESULTS: Among 320 patients enrolled, 298 patients underwent stapled IPAA while 22 underwent hand-sewn IPAA. There was no significant difference in the postoperative complications between the two groups. Regarding postoperative bowel function, stapled IPAA caused significantly less soiling (stapled vs hand-sewn: 9.1% vs 41.0%, odds ratio (OR) = 0.14, p < 0.0002), spotting (stapled vs hand-sewn: 23.2% vs 63.6%, OR = 0.17, p < 0.0001), and difficulty in distinguishing feces from flatus (stapled vs hand-sewn: 39.9% vs 63.6%, OR = 0.36, p < 0.026). No postoperative neoplasia was observed at the final follow-up in all patients. CONCLUSION: In this study, there was no clear difference in the postoperative complications between stapled and hand-sewn IPAA, but stapled IPAA resulted in better postoperative bowel function. Postoperative oncogenesis from the residual mucosa is rare. However, future cancer risk remains; thus, careful follow-up is required.

2.
Anticancer Res ; 41(11): 5539-5547, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732424

RESUMO

BACKGROUND/AIM: We aimed to investigate the prognosis of patients who received radiofrequency ablation (RFA) for liver metastases of unresectable colorectal cancer (CRC). PATIENTS AND METHODS: We retrospectively compared 147 patients treated for CRC liver metastases, who underwent RFA (n=26), resection (n=92), and chemotherapy (n=29) between 2001 and 2021. RESULTS: RFA and chemotherapy were performed for unresectable or non-operable cases, and resection was performed for suitable cases. The median overall survival (OS) was 44.9, 49.5, and 11.6 months for patients who underwent RFA, resection, and chemotherapy, respectively. RFA led to a significantly shorter OS compared to resection (p=0.027) but to a longer OS compared to chemotherapy (p=0.003). The 5-year survival rates were 34.6% and 42.4% for patients who underwent RFA and resection, respectively (p=0.508). CONCLUSION: RFA has the potential to achieve long-term survival or radical cure, even for unresectable or non-operable cases of CRC with liver metastasis.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Colorretais/patologia , Hepatectomia , Neoplasias Hepáticas/cirurgia , Ablação por Radiofrequência , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Neoplasias Colorretais/mortalidade , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/mortalidade , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/mortalidade , Estudos Retrospectivos , Fatores de Tempo
3.
Anticancer Res ; 41(11): 5821-5825, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732457

RESUMO

AIM: Anastomotic leakage (AL) in left-sided colorectal cancer is a serious complication, with an incidence rate of 6-18%. We developed a novel predictive model for AL in colorectal surgery with double-stapling technique (DST) anastomosis using auto-artificial intelligence (AI). PATIENTS AND METHODS: A total of 256 patients who underwent curative surgery for left-sided colorectal cancer between 2017 and 2021 were included. In addition to conventional clinicopathological factors, we included the type of circular stapler using DST, conventional double-row circular stapler (DCS) or EEA™ circular stapler with Tri-Staple™ technology, 28 mm Medium/Thick (Covidien, New Haven, CT, USA) which had triple-row circular stapler (TCS) as a covariate. Auto-AI software Prediction One (Sony Network Communications Inc.) was used to predict AL with 5-fold cross validation. Predictive accuracy was assessed using the area under the receiver operating characteristic curve. Prediction One also evaluated the 'importance of variables' (IOV) using a method based on permutation feature importance. RESULTS: The area under the curve of the AI model was 0.766. The type of circular stapler used was the most influential factor contributing to AL (IOV=0.551). CONCLUSION: This auto-AI predictive model demonstrated an improvement in accuracy compared to the conventional model. It was suggested that use of a TCS may contribute to a reduction in the AL rate.


Assuntos
Fístula Anastomótica/etiologia , Colectomia/efeitos adversos , Neoplasias Colorretais/cirurgia , Técnicas de Apoio para a Decisão , Aprendizado de Máquina , Grampeamento Cirúrgico/efeitos adversos , Idoso , Fístula Anastomótica/diagnóstico , Bases de Dados Factuais , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Grampeadores Cirúrgicos , Grampeamento Cirúrgico/instrumentação , Fatores de Tempo , Resultado do Tratamento
4.
Am Surg ; : 31348211056281, 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34797185

RESUMO

BACKGROUND: Remnant gastric cancer (RGC) encompasses all cancers arising from the remnant stomach. Various studies have reported on RGC and its prognosis, but no consensus on its surgical treatment and postoperative management has been reached. Moreover, the correlation between the clinicopathological characteristics and long-term outcomes of RGC remains unclear. This study investigated the clinicopathological factors associated with the long-term survival of RGC patients. METHODS: The medical records (March 1993-September 2020) of 104 RGC patients from Tokyo Medical University Hospital database were analyzed. Of these 104 patients, the medical records of 63 patients who underwent surgical curative resection were analyzed using R. Kaplan-Meier plots of cumulative incidence of RGC were made. Differences in survival rates were compared using the log-rank test. Prognostic factors were analyzed using multivariate Cox regression analysis (P < .05). RESULTS: Of the 104 RGC patients, 63 underwent total remnant stomach excision. The median time from the first surgery to the total excision was 10 years. The 5-year survival rate of the 63 RGC patients was .55 ((95% CI); .417-.671). The clinicopathological factors that were significantly associated with the long-term outcome of the RGC patients were tumor diameter (≥3.5 cm), presence or absence of combined resection of multiple organs, tumor invasion (deeper than T2), TNM stage, and postoperative morbidity. The multivariate Cox regression analysis showed that tumor invasion depth was the only independent prognostic factor for RGC patients [HR (95% CI): 5.49 (2.629-11.5), P ≤ .005]. CONCLUSIONS: Among prognostic factors, tumor invasion depth was the only independent factor affecting RGC's long-term outcome.

5.
Indian J Surg Oncol ; 12(3): 498-506, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34658577

RESUMO

Lymphocyte-to-monocyte ratio (LMR) has been reported as a biomarker for predicting the prognosis of colorectal cancer. However, the clinical usefulness of LMR requires detailed research, which can contribute to better therapeutic strategies. A cohort of 554 patients with resectable advanced colon cancer in our institution was analyzed retrospectively. An analysis of stages II and III resectable advanced colon cancer was performed. LMR was useful for predicting overall survival (OS) and relapse-free survival (RFS). The ROC curve revealed an LMR value of 2.77 as a cutoff for OS. A high LMR was an independent prognostic factor and was associated with a high hazard ratio (HR) in all cases for OS (HR = 0.530, 95% confidence interval (CI) = 0.334-0.842, p = 0.007). A high LMR was not an independent prognostic factor in stage II cases but was a predictor with the strongest association with prognosis in patients with stage III cases for OS (HR = 0.383, 95% CI = 0.160-0.915, p = 0.031). LMR is a strong predictor of prognosis in patients with stage III colon cancer and may be useful in postoperative treatment options.

6.
J Med Case Rep ; 15(1): 457, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34526110

RESUMO

BACKGROUND: Intra-abdominal desmoid tumors are rare soft tissue tumors that arise mainly in the mesentery and pelvis. Their etiology may include genetic mutations, estrogen-associated changes after childbirth, and mechanical factors such as a history of abdominal surgery. However, there are cases of intra-abdominal desmoid tumors that develop in the absence of such causes. Since they are rare, diagnosis is often difficult based on clinical findings. We encountered two cases of patients with sporadic intra-abdominal desmoid tumors with a very unusual onset and contrasting features. CASE PRESENTATION: The first patient was a 51-year-old asian man who presented with sudden onset of abdominal pain. He was referred to our department because of a giant tumor detected on abdominal ultrasonography. Imaging revealed a 19-cm tumor with internal tumoral hemorrhage; however, no definitive diagnosis was made. Tumor resection was performed for diagnostic and therapeutic purposes. The second patient was a 41-year-old asian man, and right hydronephrosis was detected on abdominal ultrasonography during a periodic medical checkup. We diagnosed invasion of the primary mesenteric tumor into the right ureter using diagnostic imaging and performed ileocecal resection with partial right ureteral resection for a definitive diagnosis and therapeutic purposes. Although the tumors of both patients had developed from the ileal mesentery, the tumors were substantially different from each other based on their imaging findings, macroscopic morphology, and progression pattern. Meanwhile, they showed similar pathological characteristics. Both consisted of bundles of collagen fibrils of spindle-shaped fibroblasts with low cell atypia. Moreover, they were diagnosed as desmoid tumors using positive immunohistochemical staining for ß-catenin. CONCLUSIONS: Neither patient had susceptibility factors for desmoid tumors, and to our knowledge, there have been very few reports to date of intra-abdominal desmoid tumors that were diagnosed because of acute abdominal pain caused by tumoral hemorrhage or asymptomatic obstructive uropathy. Furthermore, it is clinically interesting that the two patients showed contrasting progression patterns and imaging findings. Intra-abdominal desmoid tumors are rare and may present with various symptoms and findings similar to those observed in our patients. Diagnosis therefore requires experience and knowledge that is not bound by preconceptions.


Assuntos
Fibromatose Abdominal , Fibromatose Agressiva , Dor Abdominal/etiologia , Adulto , Colectomia , Fibromatose Abdominal/diagnóstico por imagem , Fibromatose Abdominal/cirurgia , Fibromatose Agressiva/diagnóstico por imagem , Fibromatose Agressiva/cirurgia , Humanos , Masculino , Mesentério/diagnóstico por imagem , Mesentério/cirurgia , Pessoa de Meia-Idade
7.
Artigo em Inglês | MEDLINE | ID: mdl-34519976

RESUMO

PURPOSE: Despite improvements in surgical techniques and devices and perioperative care of gastric cancer (GC), the rate of postoperative complications still has not decreased. If patients at high risk for postoperative complications could be identified early using biomarkers, these complications might be reduced. In this study, we investigated usefulness of the preoperative Glasgow Prognostic Score (GPS) as a predictive factor for complications after surgery in patients with stage II/III GC. METHODS: This study retrospectively analyzed the outcomes of 424 patients who underwent curative surgery for pathological stage II/III GC from February 2007 to July 2019 at a single center. The GPS was assessed within 4 days before surgery. To identify independent risk factors for postoperative complications, univariate and multivariate analyses were performed using a Cox proportional hazards model. RESULTS: The numbers of patients with a GPS of 0, 1, and 2 were 357, 55, and 12, respectively. The rate of complications after surgery was significantly higher among patients with a GPS of 1 or 2 than among patients with a GPS of 0 (p = 0.008). Multivariate analysis identified a GPS of 1 or 2 as an independent predictive factor for postoperative complications (p = 0.037). CONCLUSION: The preoperative GPS may be a useful predictive factor for postoperative complications in patients with stage II/III GC. Being aware of the risk of complications after surgery as indicated by the GPS before surgery may promote safe and minimally invasive surgery that we expect will improve outcomes in patients with a GPS of 1 or 2.

8.
Anticancer Res ; 41(9): 4471-4478, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475071

RESUMO

AIM: This study aimed to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in elderly patients with Stage I-III colon cancer for long-term oncologic outcomes. PATIENTS AND METHODS: We retrospectively reviewed 175 patients aged >75 years who underwent radical surgery for Stage I-III colon cancer between 2000 and 2015 at our institute. Overall survival (OS), cancer-specific survival (CSS), and relapse-free survival (RFS) were evaluated according to NLR values using propensity score analysis. Patients were allocated to the higher NLR (H-NLR) or the lower NLR (L-NLR) group with a cut-off value of 2.3, based on receiver operating characteristic curve. RESULTS: Before case matching, there were significant differences between the two groups for CSS (p=0.023) and RFS (p<0.001), but not for OS (p=0.069). Similar results were obtained after case matching, with significant differences observed for CSS (p=0.003) and RFS (p=0.027), but not for OS (p=0.145). CONCLUSION: NLR may be a prognostic factor in elderly patients with colon cancer.


Assuntos
Neoplasias do Colo/sangue , Neoplasias do Colo/cirurgia , Neutrófilos/metabolismo , Pontuação de Propensão , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/patologia , Procedimentos Cirúrgicos do Sistema Digestório , Intervalo Livre de Doença , Feminino , Humanos , Contagem de Linfócitos , Masculino , Estadiamento de Neoplasias , Prognóstico , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento
9.
Anticancer Res ; 41(9): 4629-4636, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475091

RESUMO

BACKGROUND/AIM: We aimed to develop a novel recurrence prediction model for stage II-III colon cancer using simple auto-artificial intelligence (AI) with improved accuracy compared to conventional statistical models. PATIENTS AND METHODS: A total of 787 patients who had undergone curative surgery for stage II-III colon cancer between 2000 and 2018 were included. Binomial logistic regression analysis was used to calculate the effect of variables on recurrence. The auto-AI software 'Prediction One' (Sony Network Communications Inc.) was used to predict recurrence with the same dataset used for the conventional statical model. Predictive accuracy was assessed by the area under the receiver operating characteristic curve (AUC). RESULTS: The AUC of the multivariate model was 0.719 (95%CI=0.655-0.784), whereas that of the AI model was 0.815, showing a significant improvement. CONCLUSION: This auto-AI prediction model demonstrates improved accuracy compared to the conventional model. It could be constructed by clinical surgeons who are not familiar with AI.


Assuntos
Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Inteligência Artificial , Progressão da Doença , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Curva ROC , Medição de Risco , Resultado do Tratamento , Adulto Jovem
10.
Clin Exp Metastasis ; 38(5): 459-466, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34406563

RESUMO

This study aimed to examine the risk factors for surgical site infection (SSI) and the association of that with recurrence in JCOG0212. The results for secondary endpoints showed that compared with the mesorectal excision (ME) alone group, ME with lateral lymph node dissection (LLND) group showed significantly longer operative time and significantly higher blood loss. These results suggested that LLND was a risk factor for SSI. All 701 patients registered in JCOG0212 were analyzed in this study. Wound infection was defined as incisional/deep SSI, and pelvic abscess and anastomotic leakage were defined as organ/space SSI. The risk factors for the incidence of SSI and the effect of SSI on relapse-free survival (RFS) were investigated. Multivariable odds ratio of Grade 2 or higher all SSI was 0.58 [95% Confidence interval: 0.36-0.93] for female (vs. male) and that of Grade 2 or higher incisional/deep SSI was 2.24 [1.03-4.86] for blood infusion. For RFS, patients with Grade 3 or higher all SSI showed poor prognosis (multivariable hazard ratio: 1.66 [1.03-2.68]). LLND is not significant factor for the incidence of all SSI. Male sex might be a risk factor of Grade 2 or higher SSI, and blood transfusion is a possible risk factor of Grade 2 or higher incisional/deep SSI. Grade 3 or higher all SSI might be a significant worse prognostic factor for lower rectal cancer.


Assuntos
Neoplasias Retais/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Adulto , Idoso , Feminino , Humanos , Incidência , Modelos Logísticos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia
11.
Cancers (Basel) ; 13(14)2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34298818

RESUMO

Patients with resectable pancreatic cancer are considered to already have micro-distant metastasis, because most of the recurrence patterns postoperatively are distant metastases. Multimodal treatment dramatically improves prognosis; thus, micro-distant metastasis is considered to be controlled by chemotherapy. The survival benefit of "regional lymph node dissection" for pancreatic head cancer remains unclear. We reviewed the literature that could be helpful in determining the appropriate resection range. Regional lymph nodes with no suspected metastases on preoperative imaging may become areas treated with preoperative and postoperative adjuvant chemotherapy. Many studies have reported that the R0 resection rate is associated with prognosis. Thus, "dissection to achieve R0 resection" is required. The recent development of high-quality computed tomography has made it possible to evaluate the extent of cancer infiltration. Therefore, it is possible to simulate the dissection range to achieve R0 resection preoperatively. However, it is often difficult to distinguish between areas of inflammatory changes and cancer infiltration during resection. Even if the "dissection to achieve R0 resection" range is simulated based on the computed tomography evaluation, it is difficult to identify the range intraoperatively. It is necessary to be aware of anatomical landmarks to determine the appropriate dissection range during surgery.

12.
Curr Med Imaging ; 17(10): 1266-1270, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34102981

RESUMO

BACKGROUND: Gastrointestinal schwannoma is not a common type of tumor, and lesions originating from the appendix are extremely rare. Herein, we report a patient with appendiceal schwannoma characterized by lymph node swelling. CASE REPORT: A 67-year-old male patient who had diabetes complained of weight loss. A computed tomography scan revealed a mass in the right side of the pelvic cavity. Moreover, a contrast-enhanced computed tomography scan showed perilesional lymph node swelling measuring up to 28 mm. A low-intensity mass was observed on T1-weighted imaging, heterogeneous high-intensity mass on T2-weighted imaging, and restricted diffusion on diffusion-weighted imaging. There were no abnormal findings on colonoscopy. Based on a preoperative examination, a differential diagnosis of either appendiceal schwannoma, carcinoid, or gastrointestinal stromal tumor was considered. During surgery, a large appendiceal mass and multiple swollen perilesional lymph nodes were observed. Therefore, ileocecal resection and D3 lymph node dissection were performed. Pathological and immunohistochemical analyses confirmed the diagnosis of appendiceal schwannoma. There were numerous swollen lymph nodes in the mesenteric region. The lymph nodes revealed reactive lymphoid hyperplasia, with enlarged follicles of various sizes and shapes with an irregular distribution. Almost all lymphocytes, except those at the germinal centers, were small. CONCLUSION: Gastrointestinal schwannoma is characterized by lymph node swelling. Appendiceal schwannoma may have characteristics, including peritumoral lymph node swelling, similar to other types of gastrointestinal schwannoma such as that in the stomach. Thus, this characteristic can be a diagnostic clue for appendiceal schwannoma.

13.
BMC Gastroenterol ; 21(1): 257, 2021 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-34118881

RESUMO

BACKGROUND: Cholangiocarcinoma is frequently observed in patients with congenital bile duct dilatation (CBDD). Most cholangiocarcinomas are adenocarcinomas. Other types, especially neuroendocrine carcinomas (NECs), are rare. To the best of our knowledge, this is the third reported case of an NEC of the common bile duct associated with CBDD and the first to receive adjuvant chemotherapy for advanced disease. CASE PRESENTATION: A 29-year-old woman presented with upper abdominal pain. Preoperative imaging indicated marked dilatation of the common bile duct and a tumor in the middle portion of the common bile duct. She was suspected of having distal cholangiocarcinoma associated with CBDD and underwent pylorus-preserving pancreaticoduodenectomy. Pathological and immunohistological findings led to a final diagnosis of large-cell NEC (pT3aN1M0 pStageIIB). The postoperative course was uneventful, and she was administered cisplatin and irinotecan every 4 weeks (four cycles) as adjuvant chemotherapy. She has remained recurrence-free for 16 months. CONCLUSIONS: NEC might be a differential diagnosis in cases of cholangial tumor associated with congenital bile duct dilatation. This presentation is rare and valuable, and to establish better treatment for NEC, further reports are necessary.


Assuntos
Neoplasias dos Ductos Biliares , Ductos Biliares Extra-Hepáticos , Carcinoma Neuroendócrino , Adulto , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/cirurgia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Dilatação , Feminino , Humanos , Recidiva Local de Neoplasia
14.
Asian J Endosc Surg ; 2021 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-34008336

RESUMO

INTRODUCTION: In recent years, a shortage of surgeons and anesthesiologists, particularly in regional hospitals, has become a social issue in Japan. In such hospitals, urgent surgery at night has been performed with difficulty. Therefore, we retrospectively assessed the outcomes of appendectomies for the patients visited at nighttime in our hospital categorized as a local university hospital. METHODS: A retrospective review was conducted on 82 patients of acute appendicitis presented to our hospital between 5:30 p.m. to 8:30 a.m., between January 2014 and April 2019. We compared patients who underwent urgent nighttime appendectomy (group A) and patients who underwent appendectomy during the daytime, or so-called short interval appendectomy (group B). The evaluated factors were preoperative characteristics (age, sex, body mass index, cardiopulmonary complications, laboratory data, body temperature, presence of the Blumberg sign, and CT findings), operation characteristics, and postoperative characteristics (surgical-site infection [SSI], complications, and length of hospital stay). RESULTS: Patients in group A were significantly younger than patients in group B. Patients in group A were significant more likely to experience an SSI. DISCUSSION: Patients diagnosed with acute appendicitis during the nighttime can undergo short interval appendectomy, which leads to a decreased risk of SSI, has no effect on length of hospital stay after surgery, and lessens medical staff burden.

15.
Surg Today ; 51(11): 1813-1818, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33907898

RESUMO

PURPOSE: Clinically relevant postoperative pancreatic fistulas (CR-POPF) occurring after distal pancreatectomy often cause intra-abdominal infections. We monitored the presence of bacterial contamination in the ascitic fluid after distal pancreatectomy to clarify the bacterial origin of intra-abdominal infections associated with CR-POPF. METHODS: In 176 patients who underwent distal pancreatectomy, ascitic fluid bacterial cultures were performed on postoperative days (POD) 1-4 and when the drainage fluid became turbid. The association between postoperative ascitic bacterial contamination and CR-POPF incidence was investigated. RESULTS: CR-POPF occurred in 18 cases (10.2%). Among the patients with CR-POPF, bacterial contamination was detected in 0% on POD 1, in 38.9% on POD 4, and in 72.2% on the day (median, day 9.5) when the drainage fluid became turbid. A univariate analysis revealed a significant difference in ascitic bacterial contamination on POD 4 (p < 0.001) and amylase level on POD 3-4 (p < 0.001). A multivariate analysis revealed the amylase level and ascitic bacterial contamination on POD 4 to be independent risk factors. CONCLUSIONS: In the CR-POPF group, ascitic bacterial contamination was not observed in the early postoperative stage, but the bacterial contamination rate increased after pancreatic juice leakage occurred. Therefore, CR-POPF-related infections in distal pancreatectomy may be caused by a retrograde infection of pancreatic juice.

16.
Anticancer Res ; 41(4): 2157-2163, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813427

RESUMO

BACKGROUND: This study assessed the efficacy and safety of biweekly trifluridine and tipiracil hydrochloride (TAS-102) with bevacizumab combination therapy for patients with metastatic colorectal cancer (mCRC). PATIENTS AND METHODS: We included 19 patients with mCRC who received TAS-102 and bevacizumab combination therapy biweekly as third-line chemotherapy. The primary endpoint was progression-free survival. RESULTS: Patients had a median age of 73 years and most (73.4%) were men. The median progression-free and overall survival were 5.6 and 11.5 months, respectively. Five (26.3%) patients achieved a response and the disease control rate was 12/19 (63.1%). One patient (5.2%) experienced neutropenia grade 3 or more. The median time from baseline performance status 0/1 to worsening to 2 or more was 10.3 months. CONCLUSION: Biweekly TAS-102 plus bevacizumab facilitates tumor shrinkage by reducing the incidence of grade 3 or more neutropenia, improving survival, and maintaining performance status. This combination may represent a treatment option for patients with late-stage mCRC receiving third- or later-line therapy.


Assuntos
Adenocarcinoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bevacizumab/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Pirrolidinas/administração & dosagem , Timina/administração & dosagem , Trifluridina/administração & dosagem , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab/efeitos adversos , Neutropenia Febril Induzida por Quimioterapia/epidemiologia , Neutropenia Febril Induzida por Quimioterapia/etiologia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Esquema de Medicação , Combinação de Medicamentos , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Pirrolidinas/efeitos adversos , Análise de Sobrevida , Timina/efeitos adversos , Resultado do Tratamento , Trifluridina/efeitos adversos
17.
J Clin Oncol ; 39(10): 1098-1107, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33560877

RESUMO

PURPOSE: It remains controversial whether primary tumor resection (PTR) before chemotherapy improves survival in patients with colorectal cancer (CRC) with asymptomatic primary tumor and synchronous unresectable metastases. PATIENTS AND METHODS: This randomized phase III study investigated the superiority of PTR followed by chemotherapy versus chemotherapy alone in relation to overall survival (OS) in patients with unresectable stage IV asymptomatic CRC and three or fewer unresectable metastatic diseases confined to the liver, lungs, distant lymph nodes, or peritoneum. Chemotherapy regimens of either mFOLFOX6 plus bevacizumab or CapeOX plus bevacizumab were decided before study entry. The primary end point was OS, which was analyzed by intention-to-treat. RESULTS: Between June 2012 and September 2019, a total of 165 patients were randomly assigned to either chemotherapy alone (84 patients) or PTR plus chemotherapy (81 patients). When the first interim analysis was performed in September 2019 with 50% (114/227) of the expected events observed among 160 patients at the data cutoff date of June 5, 2019, the Data and Safety Monitoring Committee recommended early termination of the trial because of futility. With a median follow-up of 22.0 months, median OS was 25.9 months (95% CI, 19.9 to 31.5) in the PTR plus chemotherapy arm and 26.7 (95% CI, 21.9 to 32.5) in the chemotherapy-alone arm (hazard ratio, 1.10; 95% CI, 0.76 to 1.59; one-sided P = .69). Three postoperative deaths occurred in the PTR plus chemotherapy arm. CONCLUSION: Given that PTR followed by chemotherapy showed no survival benefit over chemotherapy alone, PTR should no longer be considered a standard of care for patients with CRC with asymptomatic primary tumors and synchronous unresectable metastases.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Idoso , Anemia/etiologia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab/administração & dosagem , Bevacizumab/efeitos adversos , Neoplasias Colorretais/patologia , Terapia Combinada/efeitos adversos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Leucopenia/etiologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Avaliação de Resultados em Cuidados de Saúde/métodos
19.
Surg Today ; 51(7): 1212-1219, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33420821

RESUMO

PURPOSE: Laparoscopic hepatojejunostomy (HJ) with continuous sutures is commonly performed in laparoscopic pancreaticoduodenectomy (LPD). This study aimed to investigate the long-term surgical outcomes of HJ in LPD. METHODS: We retrospectively evaluated 103 consecutive patients who underwent pancreaticoduodenectomy via laparoscopic HJ with continuous suturing using multifilament (n = 48) or monofilament-absorbable sutures (n = 47). RESULTS: During follow-up, anastomotic stricture of HJ was identified in 8 (7.8%) patients via balloon enteroscopy-assisted cholangiography. The median time from surgery to confirmation of stricture formation was 7.6 months (range 3.6-19.4). The incidence of HJ stricture was significantly higher in patients with a thin bile duct (diameter < 6.0 mm) than in those with a thick bile duct (diameter ≥ 6.0 mm) [7/27 (25.9%) vs. 1/76 (1.3%), respectively, p < 0.01]. Similarly, it was significantly higher in the monofilament group than in the multifilament group [7/54 (13.0%) vs. 1/49 (2.0%), respectively, p = 0.04]. In the monofilament suture group, 37.5% of patients with thin bile ducts developed stricture after HJ. A multivariate analysis revealed that a thin bile duct was an independent risk factor for HJ stricture (hazard ratio: 25.3, p < 0.01). CONCLUSIONS: Stricture after laparoscopic HJ using continuous sutures frequently occurs in patients with thin bile ducts, particularly when monofilament-absorbable suture is used.

20.
Surg Endosc ; 35(5): 2386-2388, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33409595

RESUMO

BACKGROUND: Complete mesocolic excision (CME) has been demonstrated to be a useful surgical procedure for advanced colon cancer. We previously reported on laparoscopic (Lap) CME with true central vascular ligation (CVL) for advanced right-sided colon cancer. Lap CME with true CVL is highly plausible from the perspective of surgical oncology. However, true CVL of the middle colic artery (MCA) may require extensive resection of the transverse colon. The Japanese Classification of Colorectal Cancer defines D3 as main lymph node dissection around the superior mesenteric artery (SMA), and true CVL is not listed as a required condition. Our institution has been performing a Lap procedure (Lap D3/modified CME) that consists of the dissection of main lymph nodes around the root of the MCA (#223LNs) while preserving the left branch of the MCA. Two videos of a Lap D3/modified CME are presented, and the short-term outcome is reported. METHODS: Lap D3/modified CME was defined as Lap ligation surgery at the root of the right branch of the MCA that preserves the MCA with #223LNs on the resection side. The present study retrospectively examined 11 cases of Lap D3/modified CME performed at the Tokyo Medical University Hospital between 2015 and 2020. When the SMA is difficult to visualize in Type V/A cases, the SMV is pulled using some silicone string, and the surrounding lymph nodes are dissected while visualizing the SMA. RESULTS: The median operating time was 289 min, and the median blood loss was 57 ml. The median total number of dissected lymph nodes was 38, and the median number of dissected #223LNs was three. No metastasis was found in the dissected #223LNs. CONCLUSION: Although this surgery can be performed safely, we believe that this surgery needs to be performed for suitable cases by a highly experienced and skilled surgical team.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Artérias Mesentéricas/cirurgia , Colo Transverso/irrigação sanguínea , Colo Transverso/cirurgia , Neoplasias do Colo/patologia , Humanos , Ligadura , Linfonodos/patologia , Linfonodos/cirurgia , Mesocolo/cirurgia , Duração da Cirurgia , Estudos Retrospectivos
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